الفهرس 
Structure& pharmacokineticsOnly 14 pages are availabe for public view
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Abstract
MMC is an antimetabolite produced by streptomyces caespitosus. It possesses both antineoplastic and antiproliferative properities. Its antineoplastic properities derive from its ability to cross-link DNA, much like the alkylating agents, and it is used for this purpose primarily in the treatment of gastrointestinal malignancies. Furthermore MMC has been shown to inhibit fibroblast proliferation both in vivo and in vitro, hence its clinical use as a modulator of wound healing response.
In the ear surgery field, MMC was found to be of statistical significance when topically applied after myringotomy, and the patency rate was varying between 5.8 weeks as proved by Yucel in a concentration of 1 mg/mL, and 49 days as proved by Jassir, Estrem and Batra. In 2003, Jassir et al. proved that, escalating drug concentrations up to 0.4 mg/mL resulted in significantly greater patency rates, and as in previous studies, the 2.0 mg/mL dosage was significantly related to the development of otorrhea and middle ear toxicity.
On humans, Estrem and Baker (2000) proved that MMC (0.1 mL, 2 mg/mL ) pre-application exerted an enhanced patency on KTP or CO2 laser-treated TMs but for 15 minutes exposure. In 2004, D’eredita applied MMC ( 0.2 mL, 4 mg/mL) before C-LAM and demonstrated that topical MMC pre-application did not significantly affect C-LAM treated ears in terms of prolonged patency rate but application was for 5 minutes only, so that a longer exposure time would affect the results.
As regard the timing of application, Kaftan and Hosemaan (2006). concluded that the application of MMC to the intact tympanic membrane prolongs the patency of nonlaser myringotomies in rats than did the application after myringotomy
In the external auditory canal surgery, it was established that a conservative surgical approach combined with topical application of MMC can be a safe and successful method of treating fibrous atresia of the external auditory canal.
In meniere’s disease patients, remarkable hearing improvement and no recurrence of incapacitating vertiginous symptoms proved that longer-term efficacy of ES surgery using MMC can be maintained.
In nasal& PNS surgeries; it was established that MMC is an effective and reliable treatment for improving the surgical outcome for choanal atresia repair. This may obviate the need for postoperative dilations and may potentially eliminate the need for surgical stenting. MMC was also found to be safe to use during sinus surgery, and it may reduce the incidence of postoperative adhesions at the dosage of 0.4 mg/mL and 1.0-mg/mL. The topical use of MMC in patients with eosinophilic NSP showed statistically significant reduction for GM-CSF and significant and important reduction for IL5, the factors that increase eosinophil survival and prolong their presence within the polypoid tissue.
In the upper airway surgery; it was found that MMC favorably altered the clinical progression of subglottic stenosis, improved quantified airway patency and reduced the amount of subglottic collagen formation in animal models. The human trials reported also that MMC altered wound healing for glottic and subglottic stenosis and adding it to the treatment regimen significantly increased the success rate of endoscopic treatment of acquired upper airway stenosis, while the decrease in the healing response was found to have negative consequences on the vocal fold vibratory pattern, also the risk of acute airway obstruction from delayed wound healing risk should be considered in the use of MMC in clinical practice
In the digestive tract, an additional technique for treatment of nasopharyngeal stenosis using palatal obturators and topical MMC had proved its significance, and so the effectiveness of MMC in preventing caustic esophageal strictures.
MMC had proved significance also in other head and neck regions including tempromandibular joint, in ophthalmology; in dacryocystorhinostomy, to prevent restenosis in glaucoma surgery, optic nerve sheath fenestration and ptregium recurrence.